Staffing on the inpatient adolescent unit

[PeacockMaiden]

What is the normal staffing for an inpatient adolescent psych unit? Where I work, I'm in a unit with 13 co-ed adolescent patients and I'm the only nurse. They usually give me 2 floor staff.

As the nurse I have to pass meds, do admissions and discharges, deal with crisis that come up (which is daily), manage the floor staff, deal with the docs for orders or changes in conditions, transcribe all orders in the chart (we are still using paper- no computers), carry out all the labs, deal with the parents on the phone or in person, answer the unit phone (no unit secretary), do incident reports as necessary (such as for ER meds, which happen almost daily), do all the paper work, and do all the charting on the patients.

This company is that big for profit cooperation that has a bad reputation for under staffing. The other nurses who work on the unit on different shifts feel unsupported and overwhelmed too. We tell management, but they just say, "deal with it".

It is not safe for the staff or the patients. It is not a therapeutic environment. The building is old, falling apart, and the 'accommodations' are sporifice. There is only one day room with a tv and hard wooden chairs. There is no therapy happening (except one 20 minute group given by the floor staff) and virtually no activities for the kids. They sit and watch tv all day, and eventually end up acting out, since they are bored. With kids acting out daily, it triggers some other kids and it all snowballs from there.

I love working with patients with mental illness, but the way this company runs their facilities is deplorable. I feel severe anxiety and stress when I'm at work. No one at this company (even in the adult units- which are also under staffed), is happy.

Is this normal for inpatient adolescent psych?

[elkpark]

I've worked in more than one adolescent psych unit in the past with roughly the same staffing you describe (in my case, a 12 bed unit with one nurse and two techs, or a 24 bed unit with two nurses and 3-4 techs). However, your description of the physical plant and lack of programming is concerning.

Do you really mean there is no programming/therapy other than a single group run by the nursing staff? Are you talking about on the weekends, or in the evenings, or are you talking about weekdays on day shift? If they really are not running any more programming than that (there's no group therapy? No school? No OT/recreation therapy?), I'm v. surprised that anyone will pay for kids to be there (or, they're lying to the insurance companies ...) How does this place pass state and TJC surveys???

If I found myself in a situation in which I was really uncomfortable with the care being provided, I would be looking for another job, and I would get out of there as soon as possible (in fact, I have found myself in that situation in the past, and I have left as soon as possible :)). Best wishes!

[EmmieEchoElla]

Is this UHS?

[Meriwhen, ASN, BSN, MSN, RN]

Before working in California, I worked for a facility that staffed like yours did. If there were under 16 patients, it was frequently just myself as the only nurse. I would have one tech for the adolescents, one tech for the kids, and if I was lucky, a "float" tech to do whatever I needed them to. Plus additional techs for 1:1s as needed.

Now in CA, it's a 6:1 ratio, though the average load is usually 4 patients per nurse. There's at least two techs--one doing rounds and one monitoring the group rooms.

And what you are describing for their programming does NOT sound normal to me. Even in that barebones staffing place, where the accomodations weren't much better than your facility's, we had a full schedule of school, groups and activities for the patients, and left them very little time vegging in front of the TV.

[VivaLasViejas, ASN, RN]

I don't know about adolescent units, but recently I was inpatient in an adult facility and there were 3 nurses for 11 patients. It was great---there was lots of 1:1 time with them, and they led some groups. Overall we were a pretty easy bunch to deal with, so I was surprised at how great the staffing was. I can't imagine how a 1:13 ratio in an adolescent unit could be safe for either the nurses nor the patients. If I were you I would look elsewhere STAT.

[coonkine]

I feel your pain. Try (or rather, don't try) a 1 RN:40-49+ pt (~3/4 adolescent and 1/4 child) ratio. 1:1 have a staff along with 2 techs. All shifts. Sometimes a second RN but even then he/she is placed on a 1:1. You can already guess to which national health organization my hospital belongs. I wish I was exaggerating.